But what about that thing that happens, while doing seemingly ordinary things, that causes stinging pain and immediate tightening? Sometimes it’s accompanied by a spasm. Sometimes we know what preceded it, sometimes we have no idea. We don’t even know what to call it. Is it a stitch? A knot? What is that pain in my neck? What caused it? And how the heck do I get rid of it?

The reason you and I don’t know much about it is because the experts don’t really know either. It’s not straightforward in its cause or location and shows no physical evidence. With a tear, a doctor can point to that moment when it occurred – the ankle turned or the knee buckled – there’s a visible tear, there’s swelling. Tendinitis is localized, inflamed and the culprit is almost always prolonged repetitive movement. Muscle cramps are the result of deconditioning or fluid depletion, or both, that cause a sudden, temporary seize up in the muscle. But, those knots and spasms don’t leave a breadcrumb trail to follow and can last for days.

What It (Probably) Is

Our musculoskeletal system works with the brain via the nervous system to contract (tighten) certain muscles while relaxing (lengthening) opposing muscles in order to complete a task. Sometimes a portion of a muscle overrides the system and stays in the contracted or “on” position. This tight area is known as the trigger point and it’s from this point that everything goes haywire. It causes localized pain that may be dull when we aren’t moving but becomes sharp when we engage the muscle. It limits range of motion in the joints closest to it. The knot may be painful when pressed.

Sometimes the tightness emanates into the fascia – the web of connective tissue that envelopes our muscles – which may feel like the trigger point is spreading. We can also have many trigger points within a muscle causing the entire muscle, and the fascia surrounding it, to feel seized up. Occasionally, the knot may fire on and off into a spasm.

Likely Causes

Overload: If you were performing a tough workout or heavy labor prior, it may be you overdid it.

Prolonged Muscle Contraction: Holding one position for long lengths of time may cause a muscle, or portions of it, to stay in the contracted position. Examples: seated at a computer, driving, sleeping on your stomach with head turned to one side, sleeping on your side.

Stress: When we are in stressful situations, we often subconsciously tense up muscles, particularly in the shoulders and neck. Deep concentration on a task can have the same affect. Because these stressors tend to happen when we’re also seated at a desk or in a car, there’s a double threat of developing a trigger point.

Common Locations

Upper Back/Neck: The trapezius (traps) are triangular-shaped muscles located on each side of the spine that, together, look like a diamond. They taper to a point at the base of the skull, the top of the shoulder (running over and attaching to the scapulae), and the mid-point of the spine. Prolonged sitting and sleeping on the stomach can cause trigger points to form in the neck and scapula areas of the traps.

Trapezius

Middle Back: The latissimus dorsi (lats) are diagonal muscle fibers that run along the spine under the traps in a similar triangular pattern. They taper to a point at the mid-point of the spine, on the inside of the upper arms and at the lower spine. Twisting or overhead pulling are movements that may irritate the lats.

The Lats

Lower Back/Hips: Trigger points in the lower back could be in the lower lats or in one of the three hip muscles known collectively as the glutes. The glutes attach at the spine, pelvis and femur at various points on the back side of the hip. Sleeping on one side can cause tightening in the glutes. Trigger points can also form in the hamstrings (back thigh) or quadriceps (front thigh) from prolonged sitting.

Treatment

Rest: You shouldn’t do any strength training targeting the affected areas until you’re fully healed. If you need to be sitting for long periods of time, take regular breaks. If the pain is in the neck or upper back, avoid sleeping on your stomach. Avoid sleeping on your side if the pain is in the hips or lower back.

Heat: While most muscle injuries call for icing, I find heat works better on knots. Apply heat for approximately ten minutes several times a day to relax the muscle tissue and increase circulation.

Massage & Stretch: After warming, massage the area with a foam roller or tennis ball – this is called myofascial release. Use firm, steady pressure to loosen the muscle fibers. Finally, gently stretch the affected muscle.

Reduce Inflammation: The most effective way to accomplish this is to take ibuprofen or Motrin, as prescribed. But, if you’re medically prohibited from taking NSAIDS, you’ll need to use ice for inflammation reduction. Apply it for approximately ten minutes after stretching. Alternatively, you could use a hot-cold product such as Icy-Hot.

Unfortunately, it can take several days to rid yourself of trigger points. Often there’s mild soreness left behind, almost like a bruise, even after the knot has been released. But, if you’re treating it properly, it should gradually get better.

If you’re not feeling improvement within a couple of days or if it gets worse despite resting and treatment, seek out professional help. This phenomenon should NOT occur in the joints. If the pain is in any joint, including anywhere along the spine, that’s a symptom of something entirely different and needs medical attention.

Prevention

While there’s no sure fire way to prevent it, you can reduce the risk of it happening as well as keep the severity to a minimum:

My Achilles heel, so to speak, is my right trap, inside the scapula and up to the neck. It’s been an issue for me for as long as I can remember. But, strength training regularly over the last decade has made the problem less frequent and, when it does occur, short-lived and less intense. I’ve mastered it. You can conquer your pain in the neck too.